Rhytidectomy

Temporal incision behind the hairline in endoscopic midface lift (rhytidectomy). Note the shiny surface of the deep temporal fascia. This plane is dissected down to the orbital rim and connected to the midface subperiosteal plane created through the sublabial incision under the upper lip, and often through a lower eyelid incision.

A facelift, technically known as a rhytidectomy (from Ancient Greek ῥυτίς (rhytis) "wrinkle" + ἐκτομή (ektome) "excision", surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.

According to the most recent 2011 statistics from the American Society for Aesthetic Plastic Surgery, facelifts were the sixth most popular aesthetic surgery performed after liposuction, breast augmentation, abdominoplasty (tummy tuck), blepharoplasty (eyelid surgery) and breast lift.

Sublabial incision through which periosteum of maxilla is elevated in an endoscopic midface lift (rhytidectomy).

In the first 70 years of the 20th century facelifts were performed by pulling on the skin on the face and cutting the loose parts off. The first facelift was reportedly performed by Eugen Holländer in 1901 in Berlin.[1] An elderly Polish female aristocrat asked him to: "lift her cheeks and corners of the mouth". After much debate he finally proceeded to excise an elliptical piece of skin around the ears. The first textbook about facial cosmetic surgery (1907) was written by Charles Miller (Chicago) entitled "The Correction of Featural Imperfections".[2]

In the First World War (1914–1918) the Dutch surgeon Johannes Esser made one of the most famous discoveries in the field of plastic surgery to date, namely the "skin graft inlay technique,"[3] the technique was soon used on both English and German sides in the war. At the same time the British plastic surgeon Harold Delfs Gillies used the Esser-graft to school all those who flocked towards him who wanted to study under him. That’s how he earned the name "Father of 20th Century Plastic Surgery". In 1919 Dr. Passot was known to publish one of the first papers on face-lifting, this consisted mainly on the elevating and redraping of the facial skin. After this many others began to write papers on face-lifting in the 1920s. From then the esthetic surgery was being performed on a large scale, from the basis of the reconstructive surgery. The first female plastic surgeon, Suzanne Noël, played a large role in its development and she wrote one of the first books about esthetic surgery named: "Chirurgie Esthetique, son rôle social."

In 1968 Tord Skoog introduced the concept of subfacial dissection, therefore providing suspension of the stronger deeper layer rather than relying on skin tension to achieve his facelift (he publishes his technique in 1974, with subfacial dissection of the platysma without detaching the skin in a posterior direction).[4] In 1976 Mitz and Peyronie described the anatomical Superficial Musculoaponeurotic System, or SMAS,[5] a term coined by Paul Tessier, Mitz and Peyronie’s tutor in craniofacial surgery, after he had become familiar with Skoog’s technique. After Skoog died of a heart attack, the superficial muscular aponeurotic system (SMAS) concept rapidly emerged to become the standard face-lifting technique, which was the first innovative change in facelift surgery in over 50 years.[6]

Tessier, who had his background in the craniofacial surgery, made the step to a subperiostealdissection via a coronal incision.[7] In 1979, Tessier demonstrated that the subperiosteal undermining of the superior and lateral orbital rims allowed the elevation of the soft tissue and eyebrows with better results than the classic face-lifting. The objective was to elevate the soft tissue over the underlying skeleton to re-establish the patient's youthful appearance.

At the start of this period in the history of the facelift there was a change in conceptual thinking, surgeons started to care more about minimizing scars, restoring the subcutaneous volume that was lost during the ageing process and they started making use of a cranial direction of the "lift" instead of posterior.

The technique for performing a facelift went from simply pulling on the skin and sewing it back to aggressive SMAS and deep plane surgeries to a more refined facelift where variable options are considered to have an aesthetically good and a more long-lasting effect.

The difference between an aged eye and a youthful eye, looking at the distance from the cilliary margin to the inferior-most point of the orbicularis oculi muscle.

A. Increased redundancy of the nasolabial fold (caused by a descent of cheek fat) B. Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle) C. Jowl (a broken jaw line by ptosis of the platysma muscle) D. The intended effect of a facelift

A facelift is performed to rejuvenate the appearance of the face. Aging of the face is most shown by a change in position of the deep anatomical structures, notably the platysma muscle, cheek fat and the orbicularis oculi muscle.[8] These lead up to three landmarks namely, an appearance of the jowl (a broken jaw line by ptosis of the platysma muscle), increased redundancy of the nasolabial fold (caused by a descent of cheek fat) and the increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle).[8] The skin is a fourth component in the aging of the face. The ideal age for face-lifting is at age 50 or younger, as measured by patient satisfaction.[9][10][11] Some areas, such as the nasolabial folds or marionette lines, in some cases can be treated more suitably with Botox or liposculpture.[citation needed]

Contraindications to facelift surgery include severe concomitant medical problems, both physical and psychological. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes.[12] These strong relative contraindications consist primarily of diseases predisposing to poor wound healing. Patients are typically asked to abstain from taking aspirin or other blood thinners for at least one week prior to surgery. Patients motivations and expectations are an important factor in order to determine the patient’s medical status. A psychiatric illness leading to unreasonable expectations for the surgical outcome, such as a distorted perception of reality, can be a contraindication to surgery. Some kinds of hypersensitivity to anesthesia are a contraindication.

A dissection in the deep plane can mostly be performed safely, because the facial nerve innervates the facial muscles on the deep surface of these muscles (except for the muscles which are lying deep to the facial nerve, the mental nerve, the levator anguli oris and the buccinator). The fibres of the nerve are becoming more superficially medially. Therefore, the dissection of a deep plane begins further away of the surface then it ends. This allows the undermining to be carried out towards the nasolabial fold without harming the branches of the facial nerve.

Retaining ligaments

The retaining ligaments in the face provide an anchorage of superficial structures to underlying bone. Four retaining ligaments exist.[13] The platysma-cutaneous ligaments and the platysma-auricular ligament are aponeurotic condensations which connect the platysma to the dermis. The osteocutaneous ligaments, the zygomatic ligament and the mandibular ligament, are more important. They attach to the skin and bone, leading to a counteraction of gravitational forces. These ligaments should be released surgically to obtain a fully mobile facelift flap.

Injury to the greater auricular nerve is the most seen nerve injury after rhytidectomy.[14][15] Care should be taken in elevation over the sternocleidomastoid muscle, because of the terminal branches of the nerve that pass superficially to innervate the earlobe.

The composite flap is vascularised by facial, angular and/or inferior orbital arteries. The facial artery supplies the platysma and goes on as the angular artery, which connects with the branches of the arteria supratrochlearis and arteria infraorbitalis. The parts of the face elevated are in continuity in the deep-plane and the composite rhytidectomy include the SMAS layer in the lower face, subcutaneous tissue and the skin as the arteries to these parts are preserved.[16] With this option you can create a well vascularized tissue flap, which can be used to tighten the skin without loss of vascularization, this will result in fewer complications like skin slough and necrosis.

Many different procedures of rhytidectomy exist.[17] The differences are mostly the type of incision, the invasiveness and the area of the face that is treated. Each surgeon practices multiple different types of facelift surgery. At a consultation the procedure with the best outcome is chosen for every patient. Expectations of the patient, the age, possible recovery time and areas to improve are some of the many factors taken in consideration before choosing a technique of rhytidectomy.

In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. At this point, the deeper tissues (SMAS, the fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon's judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples.

The technique of a SMAS facelift, consisting of mobilisation, repositioning and fixating.

The SMAS (Superficial Musculo Aponeurotic System) layer consists of suspensory ligaments that encase the cheek fat, thereby causing them to remain in their normal position. Resuspension and securing the SMAS anatomical layer can lead to rejuvenation of the face, by counteracting aging and gravity caused laxity. Modifications to this technique led to development of the "Composite Facelift" and "Deep plane Facelift."

In order to correct the deepening of the nasolabial fold more accurately, the deep plane facelift was developed. Differing from the SMAS lift by freeing cheek fat and some muscles from their bone implement. This technique has a higher risk at damaging the facial nerve. The SMAS lift is an effective procedure to reposition the platysma muscle; however, the nasolabial fold is according to some surgeons better addressed by a deep plane facelift or composite facelift.

As well as in the deep plane facelift, in the composite facelift a deeper layer of tissue is mobilised and repositioned. The difference between these operating techniques is the extra repositioning and fixation of the orbicularis oculi muscle in the composite facelift procedure. The malar crescent caused by the orbicularis oculi ptosis can be addressed in a composite facelift.

The mid face area, the area between the cheeks, flattens and makes a woman’s face look slightly more masculine. The mid face-lift is suggested to people where these changes occur, yet without a significant degree of jowling or sagging of the neck. In these cases a mid face-lift is sufficient to rejuvenate the face opposed to a full facelift, which is a more drastic surgery. The ideal candidates for a mid face-lift is when a person is in his 40s, or if the cheeks appear to be sagging and the nasolabial area has laxity or skin folds. To achieve a younger appearance the surgeon makes several small incisions along the hairline and inside the mouth, this way the fatty tissue layers can be lifted and repositioned. This way there are practically no scars. The fatty layer that lies over the cheekbones is also lifted and repositioned. This improves the nose-to-mouth lines and the roundness over the cheekbones. The recovery time is rather short and this procedure is often combined with a blepharoplasty (eyelid surgery)

The mini-facelift is the least invasive type of facelift which is similar to a full facelift, the only difference is the omission of the neck lift in the mini lift procedure. It is also called the ‘S’ lift because of the shape of the incision that is used or the ‘short-scar’ facelift. This lift is a more temporary solution to the ageing of the face which also has less downtime and is done on people who have deep nasolabial folds, sagging facial structures, yet still have a firm and well-contoured neck. The position of the incision is usually made from the hairline around the ear with scars hidden in the natural crease of the skin. The mini lift can be performed with an endoscope, which is used to reposition the soft tissues. After this, the skin is repositioned by the surgeon with small sutures. This type of lift is a good alternative to the full facelift to people with premature ageing.

Blue represents the incisions in the Skin only facelift. Green represents the S-lift. Red is the extensive undermining done in several facelift techniques.

The subperiosteal facelift technique is done by vertically lifting the soft tissues of the face, completely separating it from the underlying facial bones and elevating it to a more esthetically pleasing position, correcting deep nasolabial folds and sagging cheeks. The technique is often combined with standard techniques, which provide a long-lasting rejuvenation of the face and is done in all age groups. The difference between this and other lifts is that the subperiosteal facelift has a longer period of facial swelling after the procedure.

With the skin-only facelift only the skin of the face is lifted and not the underlying SMAS, muscles or other structures. The skin itself lacks the elasticity and laxity in older patiënts, that is why the longevity of this lift is short, usually the lift re-sags within 6 to 12 months after the procedure. The reason that this option is considered is that it has fewer complications and isn’t as technically demanding as the SMAS or other types of lifts. A possible alternative method for performing this type of facelift, is through the use of a spiral needle; depending on the thickness of the lifting area, the choice of needle diameter plus the optimization of the depth at which the treatment is performed enables the surgeon to determine the tightness of the lift itself.

The term MACS-lift – or Minimal Access Cranial Suspension lift – allows for the correction of sagging facial features through a short, minimal incision, elevating them vertically by suspending them from above. There are many advantages to having a MACS facelift versus a traditional facelift. For starters, the MACS-lift uses a shorter scar that is in front of the ear, instead of behind, which is much easier to hide. Overall, the MACS-lift surgery is safer because less skin is raised. This means that there is less risk of bleeding and nerve damage. The operation also takes less time, lasting 2.5 hours instead of the 3.5 hours that the traditional facelift requires. There is also a shorter recovery period, 2–3 weeks instead of 3–4 weeks. Finally, the results of the MACS-lift are very natural while the traditional facelift will often result in a "windswept" look. The MACS lift has been successfully used for to correct complication after thread-lift with APTOS[18]

The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps or infection. Although the facial plastic surgeon attempts to prevent and minimise the risk of complications, a rhytidectomy can have complications. As a risk to every operation, complications can be derived as a reaction to the anesthetics.

Nerve injury can be obtained during rhytidectomy. This kind of injury can be temporary or permanent and harm can be done to either sensory or motor nerves of the face. As an sensory nerve, the great auricular nerve is the most common nerve to get injured at a facelift procedure.[15][19] The most injured motor nerve is the facial nerve.[15][24]

Skin necrosis can occur after a facelift operation. Smoking increases the risk of skin necrosis 12-fold.[12] Scarring is considered a complication of facelift surgery. Hypertrophic scars can appear. A facelift requires skin incisions; however, the incisions in front of and behind the ear are usually inconspicuous.

Hair loss in the portions of the incision within the hair-bearing scalp can rarely occur. A hairline distortion can result after undergoing a rhytidectomy. Especially facial hair by men after a facelift procedure. There is a high incidence of alopecia after rhytidectomy.[25][26] The permanent hair loss is mostly seen at the incision site in the temporal areas. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance if appropriate techniques are not employed to address this issue. Achieving a natural appearance following surgery in men can be more challenging due to their hair-bearing preauricular skin. In both men and women, one of the signs of having had a facelift can be an earlobe which is pulled forwards and/or distorted. If too much skin is removed, or a more vertical vector not employed, the face can assume a pulled-back, "windswept" appearance. This appearance can also be due to changes in bone structure that generally happen with age.[2]

One of the most often overlooked (or not discussed) areas of a traditional facelift procedure is the effects on the anatomical positioning and angles of the ears. Most patients are, in many cases, not made aware that the vector forces in a facelift will lower the ears as well as change the angle of the ears. Ear lowering can be as much as 1 cm and change in the angle as much as 10 degrees.

Infection is a rare complication for patients who have undergone a rhytidectomy.[27] Staphylococcus is the most usual causative organism for an infection after facelift surgery.[14]

^Marcus, BC (August 2012). "Rhytidectomy: current concepts, controversies and the state of the art". Current Opinion in Otolaryngology & Head and Neck Surgery. 20 (4): 262–6. doi:10.1097/MOO.0b013e328355b175. PMID22894994.

^Cohen, SR; Webster, RC (May 1983). ""How I do it"—head and neck and plastic surgery. A targeted problem and its solution. Primary rhytidectomy—complications of the procedure and anesthetic". The Laryngoscope. 93 (5): 654–6. PMID6843261.

1.
Temporal fascia
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The temporal fascia covers the Temporalis muscle. It is a strong, fibrous investment, covered, laterally, by the Auricularis anterior and superior, by the galea aponeurotica, the superficial temporal vessels and the auriculotemporal nerve cross it from below upward. A small quantity of fat, the branch of the superficial temporal artery. It affords attachment by its surface to the superficial fibers of the Temporalis. The parotid fascia proceeds to the temporal fascia and this article incorporates text in the public domain from the 20th edition of Grays Anatomy

2.
Skin
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Skin is the soft outer tissue covering vertebrates. Other animal coverings, such as the arthropod exoskeleton have different developmental origin, structure, the adjective cutaneous means of the skin. In mammals, the skin is an organ of the system made up of multiple layers of ectodermal tissue. Skin of a different nature exists in amphibians, reptiles, all mammals have some hair on their skin, even marine mammals like whales, dolphins, and porpoises which appear to be hairless. The skin interfaces with the environment and is the first line of defense from external factors, for example, the skin plays a key role in protecting the body against pathogens and excessive water loss. Its other functions are insulation, temperature regulation, sensation, severely damaged skin may heal by forming scar tissue. This is sometimes discoloured and depigmented, the thickness of skin also varies from location to location on an organism. The skin on the palms and the soles of the feet is 4 mm thick, the speed and quality of wound healing in skin is promoted by the reception of estrogen. Primarily, fur augments the insulation the skin provides but can serve as a secondary sexual characteristic or as camouflage. On some animals, the skin is hard and thick. Reptiles and fish have hard scales on their skin for protection. Amphibian skin is not a barrier, especially regarding the passage of chemicals via skin and is often subject to osmosis. For example, a sitting in an anesthetic solution would be sedated quickly. Amphibian skin plays key roles in everyday survival and their ability to exploit a range of habitats. Keratinocytes are the cells, constituting 95% of the epidermis, while Merkel cells, melanocytes. Keratinocytes from the stratum corneum are eventually shed from the surface, the epidermis contains no blood vessels, and cells in the deepest layers are nourished by diffusion from blood capillaries extending to the upper layers of the dermis. The epidermis and dermis are separated by a sheet of fibers called the basement membrane. The dermis is the layer of skin beneath the epidermis consists of connective tissue and cushions the body from stress

3.
Neck
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The neck is the part of the body, on many vertebrates, that separates the head from the torso or trunk. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the arteries and jugular veins. In anatomy, the neck is called by its Latin names, cervix or collum, although when used alone, in context, the word cervix more often refers to the uterine cervix. Thus the adjective cervical may refer either to the neck or to the uterine cervix, the neck contains vessels that links structures in the head to the body. In humans these structures include part of the esophagus, larynx, trachea, thyroid and parathyroid glands, lymph nodes, major blood vessels present include the carotid arteries and the jugular veins. Cervical lymph nodes surround the blood vessels, the thyroid gland and parathyroid gland are endocrine glands involved in the regulation of cellular metabolism and growth, and blood calcium levels. The shape of the neck in humans is formed from the part of the vertebral column at the back. Around these sit soft tissues, including muscles, and between and around these sit the other structures mentioned above, muscles of the neck attach to the base of the skull, the hyoid bone, the clavicles and the sternum. The large platysma, sternocleidomastoid muscles contribute to the shape at the front, a number of other muscles attach to and stem from the hyoid bone, facilitating speech and playing a role in swallowing. Sensation to the front areas of the neck comes from the roots of nerves C2-4, the cervical region of the human spine is made up of seven cervical vertebrae referred to as C-1 to C-7, with cartilaginous discs between each vertebral body. The spinal cord sits within the part of the vertebral column. The spinal column carries nerves that carry sensory and motor information from the brain down to the rest of the body, from top to bottom the cervical spine is gently curved in convex-forward fashion. In addition to coming from and within the human spine. In the middle line below the chin can be felt the body of the bone, just below which is the prominence of the thyroid cartilage called Adams apple. Still lower the cricoid cartilage is easily felt, while between this and the notch the trachea and isthmus of the thyroid gland may be made out. At the side the outline of the muscle is the most striking mark. The upper part of the former contains the submaxillary gland also known as the submandibular glands, the line of the common and the external carotid arteries may be marked by joining the sterno-clavicular articulation to the angle of the jaw

4.
Twilight anesthesia
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Twilight anesthesia is an anesthetic technique where a mild dose of general anesthesia is applied to induce anxiolysis, hypnosis, and anterograde amnesia. The patient is not unconscious, but sedated, generally, twilight anesthesia causes the patient to forget the surgery and the time right after. It is used for a variety of procedures and for various reasons. Twilight anesthesia is commonly known as sleep and calls for an easy awakening. Anesthesia is used to control pain by using medicines that reversibly block nerve conduction near the site of administration, therefore, generating a loss of sensation at the area administered. Close monitoring by the anesthesiologist will sometimes be provided, to keep the patient comfortable during a medical procedure. It can also help control breathing, blood pressure, blood flow, and heart rate and rhythm, there are four levels of sedation by anesthesia. This level called Minimal sedation causes anxiolysis, an induced state in which the patient responds normally to verbal commands. Although the cognition and coordination of the patient are impaired, cardiovascular, breathing tubes are not required for this type of anesthesia. Ventilatory functions may be impaired, breathing tubes are required, in this level called Anesthesia, a combination of general anesthesia and spinal or major regional anesthesia. It does not include local anesthesia, ventilatory function is often impaired and cardiovascular functions may be impaired. Several factors are taken into consideration when determining which level of anesthesia is used under which type of medical procedures, along with the factors determined, different types of anesthesia medications are used depending on the medical procedure being done. The same drugs used in general anesthesia are also used for anesthesia, except in smaller doses. These drugs can be administered via gases, such as oxide, or intravenously, with drugs such as ketamine, propofol. Twilight anesthesia alone is not used to provide relief from pain, therefore. As discussed in the levels of sedation by anesthesia, assistance with breathing tubes are not generally used for type of anesthesia. A few studies have been geared towards studying the effects of post operative analgesic regimes that measure the quality of recovery period, factors other than degree of analgesia and presence of analgesic agent-related side effects may potentially influence these outcomes. Twilight anesthesia is applied to types of medical procedures and surgeries

5.
Breast augmentation
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A breast implant is a prosthesis used to change the size, shape, and contour of a woman’s breast. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery, there are three general types of breast implant devices, defined by their filler material, saline solution, silicone gel, and composite filler. Composite implants are not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks. For the correction of male breast defects and deformities, the implant is the breast prosthesis used for the reconstruction. Since the late century, breast implants have been used to surgically augment the size, modify the shape. In 1889, surgeon Robert Gersuny experimented with paraffin injections, with disastrous results, in the mid-twentieth century, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, in 1964, the French company Laboratoires Arion developed and manufactured the saline breast implant, filled with saline solution, and then introduced for use as a medical device in 1964. Today, there are two types of breast implants commonly used for mammoplasty, breast reconstruction, and breast augmentation procedures, Silicone implant filled with viscous silicone gel. The saline breast implant—filled with saline solution —was first manufactured by the Laboratoires Arion company, in France, the contemporary models of saline breast implant are manufactured with thicker, room-temperature vulcanized shells made of a silicone elastomer. Saline breast implants have enjoyed popularity in the rest of the world. The technical goal of saline-implant technology was a less invasive surgical technique for emplacing an empty breast implant device through a smaller surgical incision. As a medical technology, there are five generations of silicone breast implant. The Cronin–Gerow Implant, prosthesis model 1963, was a silicone rubber envelope-sac, shaped like a teardrop, yet, in clinical practice, second-generation breast implants proved fragile, and suffered greater incidences of shell rupture, and of filler leakage through the intact device shell. After reviewing the data, the U. S. S. The third technological development was the double lumen breast implant device, the two-fold, technical goal was, the cosmetic benefits of silicone-gel enclosed in saline solution, a breast implant device the volume of which is post-operatively adjustable. Nevertheless, the complex design of the double-lumen breast implant suffered a device-failure rate greater than that of single-lumen breast implants. The contemporary versions of second-generation breast implant devices are the Becker Expandable models of breast implant, sociologically, the manufacturers of prosthetic breasts then designed and made anatomic models and shaped models that realistically corresponded with the breast- and body- types of women. These implants are commonly referred to as gummy bear breast implants for their firm, pliant consistency, revision and reconstruction, to revise the outcome of a previous breast reconstruction surgery

6.
Abdominoplasty
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Abdominoplasty or tummy tuck is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of skin and fat from the middle and lower abdomen in order to tighten the muscle. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss, abdominoplasty operations vary in scope and are frequently subdivided into categories. Depending on the extent of the surgery, a complete abdominoplasty can take from 1 to 5 hours, a partial abdominoplasty can be completed between 1 and 2 hours. In general, a complete abdominoplasty follows these steps, An incision is made from hip to hip just above the pubic area, another incision is made to free the navel from the surrounding skin. The skin is detached from the wall to reveal the muscles. The muscle fascia wall is tightened with sutures, liposuction is often used to refine the transition zones of the abdominal sculpture. A dressing and sometimes a compression garment are applied and any excess fluid from the site is drained, a partial abdominoplasty proceeds as follows, A smaller incision is made. The skin and fat of the abdomen are detached in a more limited fashion from the muscle fascia. The skin is stretched down and excess skin removed, sometimes the belly button stalk is divided from the muscle below and the belly button slid down lower on the abdominal wall. Sometimes a portion of the muscle fascia wall is tightened. Liposuction is often used to contour the transition zone, the flap is stitched back into place. An extended abdominoplasty is a complete abdominoplasty plus a lateral thigh lift and this is an advanced technique that takes a little more than four and half hours to perform. Conventional abdominoplasty tightens muscles in a vertical line, in this new method, known as high lateral tension abdominoplasty, in addition to vertical-line tightening, muscles are tightened horizontally. The final result with this technique is a flat abdomen with significantly better-defined waistline. This new technique, also known as an extended mini abdominoplasty, through this smaller incision, excess skin is removed and the belly button is temporarily detached, floating above the muscles during this process. The muscles are tightened and reshaped from sternum to pubic area, the skin is then tightened and the belly button is reattached, or moved down one or two cm if desired. Liposuction may also be performed to achieve desirable results, a circumferential abdominoplasty is an extended abdominoplasty plus a buttock lift

7.
Periosteum
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The periosteum is a membrane that covers the outer surface of all bones, except at the joints of long bones. Endosteum lines the surface of all bones. The periosteum consists of irregular connective tissue. It is divided into a fibrous layer and inner cambium layer. The fibrous layer contains fibroblasts, while the layer contains progenitor cells that develop into osteoblasts. These osteoblasts are responsible for increasing the width of a long bone, after a bone fracture the progenitor cells develop into osteoblasts and chondroblasts, which are essential to the healing process. As opposed to osseous tissue, the periosteum has nociceptive nerve endings and it also provides nourishment by providing the blood supply to the body from the marrow. The periosteum is attached to the bone by strong collagenous fibers called Sharpeys fibres and it also provides an attachment for muscles and tendons. The periosteum that covers the surface of the bones of the skull is known as the pericranium. The word Periosteum is derived from the Greek Peri-, meaning surrounding, the Peri refers to the fact that the Periosteum is the outermost layer of long bones, surrounding other inner layers

8.
Berlin, Germany
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Berlin is the capital and the largest city of Germany as well as one of its constituent 16 states. With a population of approximately 3.5 million, Berlin is the second most populous city proper, due to its location in the European Plain, Berlin is influenced by a temperate seasonal climate. Around one-third of the area is composed of forests, parks, gardens, rivers. Berlin in the 1920s was the third largest municipality in the world, following German reunification in 1990, Berlin once again became the capital of all-Germany. Berlin is a city of culture, politics, media. Its economy is based on high-tech firms and the sector, encompassing a diverse range of creative industries, research facilities, media corporations. Berlin serves as a hub for air and rail traffic and has a highly complex public transportation network. The metropolis is a popular tourist destination, significant industries also include IT, pharmaceuticals, biomedical engineering, clean tech, biotechnology, construction and electronics. Modern Berlin is home to world renowned universities, orchestras, museums and its urban setting has made it a sought-after location for international film productions. The city is known for its festivals, diverse architecture, nightlife, contemporary arts. Since 2000 Berlin has seen the emergence of a cosmopolitan entrepreneurial scene, the name Berlin has its roots in the language of West Slavic inhabitants of the area of todays Berlin, and may be related to the Old Polabian stem berl-/birl-. All German place names ending on -ow, -itz and -in, since the Ber- at the beginning sounds like the German word Bär, a bear appears in the coat of arms of the city. It is therefore a canting arm, the first written records of towns in the area of present-day Berlin date from the late 12th century. Spandau is first mentioned in 1197 and Köpenick in 1209, although these areas did not join Berlin until 1920, the central part of Berlin can be traced back to two towns. Cölln on the Fischerinsel is first mentioned in a 1237 document,1237 is considered the founding date of the city. The two towns over time formed close economic and social ties, and profited from the right on the two important trade routes Via Imperii and from Bruges to Novgorod. In 1307, they formed an alliance with a common external policy, in 1415 Frederick I became the elector of the Margraviate of Brandenburg, which he ruled until 1440. In 1443 Frederick II Irontooth started the construction of a new palace in the twin city Berlin-Cölln

9.
Harold Gillies
–
Sir Harold Delf Gillies was a New Zealand-born, and later London-based, otolaryngologist who is widely considered the father of plastic surgery. Gillies was born in Dunedin, New Zealand, following the outbreak of World War I he joined the Royal Army Medical Corps. Gillies, eager after seeing Valadier experimenting with nascent skin graft techniques, then decided to leave for Paris and he saw him remove a tumour on a patients face, and cover it with jaw skin taken from the patient. This rapidly proved inadequate and a new hospital devoted to facial repairs was developed at Sidcup, the Queens Hospital opened in June 1917 and with its convalescent units provided over 1,000 beds. There Gillies and his colleagues developed many techniques of plastic surgery, the hospital, later to become Queen Marys Hospital, was at Frognal House. For his war services Gillies was knighted in the Birthday Honours list of June 1930, william Arbuthnot-Lane commented, Better late than never. In 1930 Gillies invited his cousin, Archibald McIndoe to join the practice and this was the point at which McIndoe became committed to plastic surgery, in which he too became pre-eminent. During World War II Gillies acted as a consultant to the Ministry of Health, the RAF and his own work continued at Rooksdown House, part of the Park Prewett Hospital, Basingstoke. During this period, and after the war, he trained many doctors from Commonwealth nations in plastic surgery, instead of retiring at the end of the Second World War Gillies had to keep working as he had insufficient savings. In 1946, he and a colleague carried out one of the first sex reassignment surgeries from female to male on Michael Dillon. In 1951 he and colleagues carried out one of the first modern sex reassignment surgery from male to female using a technique on Roberta Cowell. Gillies made a visit to New Zealand in 1956 after an absence of 51 years, gilles suffered a slight cerebral thrombosis while undertaking a major operation at the age of 78 on the damaged leg of an 18-year-old girl on 3 August 1960. Gillies died on 10 September 1960 at The London Clinic, at 20 Devonshire Place, despite earning an estimated ₤30,000 a year between the First and Second World Wars he left an estate of only ₤21,161. Gillies married Kathleen Margaret Jackson on 9 November 1911, in London and his eldest son, John Gillies, flew Spitfires with No.92 Squadron RAF in World War II. John Gillies was shot down over France on 23 May 1940 and his youngest son Michael Thomas Gillies followed his father into medicine. In addition to his career as a surgeon, he was also a champion golfer, for many years his home was at 71 Frognal, in the heart of Londons Hampstead village. A blue plaque on the front of that house now commemorates his life, in 2015, Gonville and Caius College, Cambridge built 12 houses and named their road Harold Gillies Close in his honour. Actor Daniel Gillies is his descendant, ISBN 0-906923-08-5 Gillies HD, Millard DR

10.
Platysma
–
The platysma is a superficial muscle that overlaps the sternocleidomastoid. It is not a true symphysis as there is no cartilage between the two sides of the mandible. Fibres at the back of the cross the mandible, some being inserted into the bone below the oblique line, others into the skin. Many of these fibers blend with the muscles about the angle, sometimes fibers can be traced to the zygomaticus, or to the margin of the orbicularis oris. Beneath the platysma, the jugular vein descends from the angle of the mandible to the clavicle. A more or less independent fasciculus, the minor, may extend from the fascia over the trapezius to fascia over the insertion of the sternocleidomastoideus. The platysma is supplied by cervical branch of the facial nerve, when the entire platysma is in action it produces a slight wrinkling of the surface of the skin of the neck in an oblique direction. However, the plays only a minor role in depressing the lip which is primarily performed by the depressor anguli oris. In a similar fashion to other muscles, the platysma is vulnerable to tears, strains, the platysma is vulnerable to neck injuries that may penetrate it. A type of medical imagining called CTA used to visualise arterial and venous vessels is useful to minimise the number of neck explorations, another area of importance of the platysma lies in plastic surgery. Neck bands in the area become most noticeable with age, aggravated by weightlifting or facelift, if it doesnt heal with time, there are many many options to correct this, Botox/Dysport/Xeomin and platysmaplasty. This article incorporates text in the domain from the 20th edition of Grays Anatomy Books Susan Standring, Neil R. Borley. Grays anatomy, the basis of clinical practice

11.
Craniofacial surgery
–
Although craniofacial treatment often involves manipulation of bone, craniofacial surgery is not tissue-specific, i. e. craniofacial surgeons deal with bone, skin, nerve, muscle, teeth, etc. Training in craniofacial surgery requires completion of a Craniofacial surgery fellowship, such fellowships are available to individuals who have completed residency in oral and maxillofacial surgery, plastic and reconstructive surgery, or ENT surgery. Those who have completed residency in oral and maxillofacial surgery may be either single degree or dual-degree surgeons with no differences, there is no specific board for Craniofacial surgery. In the US, cleft and Craniofacial centers are found in major academic centers with a few exceptions, the bones of the human skull are joined together by cranial sutures. The anterior fontanelle is where the metopic, saggital and coronal sutures meet, normally the sutures gradually fuse within the first few years after birth. In infants where one or more of the sutures fuses too early the growth of the skull is restricted, growth in the skull is perpendicular to the sutures. When a suture fuses too early, the perpendicular to that suture will be restricted. The expanding brain is the stimulus for the rapid growth of the skull in the first years of life. Inhibited growth potential of the skull can restrict the volume, needed by the brain, in cases in which the compensation does not effectively provide enough space for the growing brain, craniosynostosis results in increased intracranial pressure. Craniosynostosis is called simple when one suture is involved, and complex when two or more sutures are involved and it can occur as part of a syndrome or as an isolated defect. There are several classifications of deformities of the skull, we will discuss them in order of prevalence. In scaphocephaly the saggital suture is prematurely fused, the saggital suture runs from the front to the back of the head. The shape of this deformity is a narrow head, formed like a boat. The incidence of scaphocephaly is 2.8 per 10000 births in the Netherlands and is therefore the most common form of craniosynostosis, in trigonocephaly the metopic suture is prematurely fused. The metopic suture is situated in the line of the forehead. Premature fusion of this causes the forehead to become pointed. The incidence of trigonocephaly is 1 -1.9 per 10000 births in the Netherlands, in plagiocephaly one of the coronal sutures is prematurely fused. The coronal sutures run over the top of the head, just in front of the ears, the shape of this deformity is an asymmetrical distortion as you can see in figure 2

12.
Subperiosteal
–
The periosteum is a membrane that covers the outer surface of all bones, except at the joints of long bones. Endosteum lines the surface of all bones. The periosteum consists of irregular connective tissue. It is divided into a fibrous layer and inner cambium layer. The fibrous layer contains fibroblasts, while the layer contains progenitor cells that develop into osteoblasts. These osteoblasts are responsible for increasing the width of a long bone, after a bone fracture the progenitor cells develop into osteoblasts and chondroblasts, which are essential to the healing process. As opposed to osseous tissue, the periosteum has nociceptive nerve endings and it also provides nourishment by providing the blood supply to the body from the marrow. The periosteum is attached to the bone by strong collagenous fibers called Sharpeys fibres and it also provides an attachment for muscles and tendons. The periosteum that covers the surface of the bones of the skull is known as the pericranium. The word Periosteum is derived from the Greek Peri-, meaning surrounding, the Peri refers to the fact that the Periosteum is the outermost layer of long bones, surrounding other inner layers

13.
Dissection
–
Dissection, is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause of death in humans and it is carried out by or demonstrated to biology and anatomy students in high school and medical school. Less advanced courses typically focus on subjects, such as small formaldehyde-preserved animals. Consequently, dissection is typically conducted in a morgue or in an anatomy lab, dissection has been used for centuries to explore anatomy. Objections to the use of cadavers have led to the use of alternatives including virtual dissection of computer models, plant and animal bodies are dissected to analyze the structure and function of its components. Dissection is practised by students in courses of biology, botany, zoology, and veterinary science, in medical schools, students dissect human cadavers to learn anatomy. Dissection is used to help to determine the cause of death in autopsy and is an part of forensic medicine. A key principle in the dissection of human cadavers is the prevention of disease to the dissector. Specimens are dissected in morgues or anatomy labs, when provided, they are evaluated for use as a fresh or prepared specimen. A fresh specimen may be dissected within some days, retaining the characteristics of a living specimen, a prepared specimen may be preserved in solutions such as formalin and pre-dissected by an experienced anatomist, sometimes with the help of a diener. This preparation is sometimes called prosection, most dissection involves the careful isolation and removal of individual organs, called the Virchow technique. An alterative more cumbersome technique involves the removal of the organ body. This technique allows a body to be sent to a director without waiting for the sometimes time-consuming dissection of individual organs. Dissection of individual organs involves accessing the area in which the organ is situated, for example, when removing the heart, connects such as the superior vena cava and inferior vena cava are separated. If pathological connections exist, such as a fibrous pericardium, then this may be deliberately dissected along with the organ, Human dissections were carried out by the Greek physicians Herophilus of Chalcedon and Erasistratus of Chios in the early part of the third century BC. During this period, the first exploration into full human anatomy was performed rather than a base knowledge gained from problem-solution delving, before and after this time investigators appeared to largely limit themselves to animals. While there was a taboo within the Greek culture concerning human dissection. For a time, Roman law forbade dissection and autopsy of the human body, Galen, for example, dissected the Barbary macaque and other primates, assuming their anatomy was basically the same as that of humans

14.
Anatomical terms of location
–
Standard anatomical terms of location deal unambiguously with the anatomy of animals, including humans. All vertebrates have the basic body plan – they are strictly bilaterally symmetrical in early embryonic stages. That is, they have left and right halves if divided down the centre. For these reasons, the directional terms can be considered to be those used in vertebrates. By extension, the terms are used for many other organisms as well. While these terms are standardized within specific fields of biology, there are unavoidable, sometimes dramatic, for example, differences in terminology remain a problem that, to some extent, still separates the terminology of human anatomy from that used in the study of various other zoological categories. The vertebrates and Craniata share a heritage and common structure. To avoid ambiguities this terminology is based on the anatomy of each animal in a standard way, for humans, one type of vertebrate, anatomical terms may differ from other forms of vertebrates. Thus what is on top of a human is the head, whereas the top of a dog may be its back, for example, many species are not even bilaterally symmetrical. In these species, terminology depends on their type of symmetry, all descriptions are with respect to the organism in its standard anatomical position, even when the organism in question has appendages in another position. This helps avoid confusion in terminology when referring to the organism in different postures. In humans, this refers to the body in a position with arms at the side. While the universal vertebrate terminology used in medicine would work in human medicine. Many anatomical terms can be combined, either to indicate a position in two axes simultaneously or to indicate the direction of a movement relative to the body, for example, anterolateral indicates a position that is both anterior and lateral to the body axis. There is no limit to the contexts in which terms may be modified to qualify each other in such combinations. Generally the modifier term is truncated and an o or an i is added in prefixing it to the qualified term, where desirable three or more terms may be agglutinated or concatenated, as in anteriodorsolateral. Such terms sometimes used to be hyphenated, but the tendency is to omit the hyphen. There is however little basis for any rule to interfere with choice of convenience in such usage

15.
Rejuvenation (aging)
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Rejuvenation is a medical discipline focused on the practical reversal of the aging process. Rejuvenation is distinct from life extension, life extension strategies often study the causes of aging and try to oppose those causes in order to slow aging. Rejuvenation is the reversal of aging and thus requires a different strategy, rejuvenation can be a means of life extension, but most life extension strategies do not involve rejuvenation. Various myths tell the stories about the quest for rejuvenation, an ancient Chinese emperor actually sent out ships of young men and women to find a pearl that would rejuvenate him. This led to a myth among modern Chinese that Japan was founded by these people, in some religions, people were to be rejuvenated after death prior to placing them in heaven. The stories continued well into the 16th century, a famous Spanish explorer Juan Ponce de León led the expedition around the Caribbean islands and into Florida to find the Fountain of Youth. Led by the rumors, the expedition continued the search and many perished, the Fountain was nowhere to be found as locals were unaware of its exact location. Since the emergence of philosophy, sages and self-proclaimed wizards always made efforts to find the secret of youth, both for themselves and for their noble patrons and sponsors. It was widely believed that some potions may restore the youth, another commonly cited approach was attempting to transfer the essence of youth from young people to old. Some examples of this approach were sleeping with virgins or children, the quest for rejuvenation reached its height with alchemy. Although the set goal was not achieved, alchemy paved the way to the scientific method and this was one of the first medically accepted rejuvenation therapies. The technique brought him a deal of money, although he was already independently wealthy. As his work out of favor, he went from being a highly respected surgeon to a subject of ridicule. By the early 1930s, over 500 men had been treated in France by his rejuvenation technique, noteworthy people who had the surgery included Harold McCormick, chairman of the board of International Harvester Company, and the aging premier of Turkey. Swiss doctor Paul Niehans, who was one of the fathers of cellular therapy, Fresh cell therapy is mainly the use of live animal embryo organs cells which are injected into the patient with the purpose of achieving a revitalizing effect. These cells are extracted from sheep’s fetuses because in comparison to other animals, like pigs, rabbits and cows, sheep are clean animals. Of course animal cells are not able to be included in human tissue, thats why this rejuvenation technology, despite the harsh criticism is practiced to this day. In fiction, there is an amount of work being done on possibilities of rejuvenation treatments

16.
Nasolabial fold
–
The nasolabial folds, commonly known as smile lines or laugh lines, are facial features. They are the two skin folds that run from side of the nose to the corners of the mouth. They are defined by facial structures that support the fat pad. They separate the cheeks from the upper lip, the term derives from Latin nasus for nose and labium for lip. With ageing the fold may grow in length and depth, dermal fillings may be used to replace lost fats and collagen in this facial area

17.
Orbicularis oculi muscle
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The orbicularis oculi is a muscle in the face that closes the eyelids. There are at least 3 clearly defined sections of the orbicularis muscle, however, it is not clear whether the lacrimal section is a separate section, or whether it is just an extension of the Preseptal orbicularis and the Pretarsal orbicularis sections. The palpebral portion contains the Preseptal orbicularis and the Pretarsal orbicularis muscles, the lacrimal orbicularis facilitates the tear pump into the lacrimal sac. The muscle acts to close the eye, and is the only capable of doing so. Loss of function for any results in an inability to close the eye. The palpebral portion acts involuntarily, closing the lids gently, as in sleep or in blinking, the orbital portion is subject to conscious control. When the entire muscle is brought into action, the skin of the forehead, temple, and cheek is drawn toward the medial angle of the orbit, and the eyelids are firmly closed, as in photophobia. The skin thus drawn upon is thrown into folds, especially radiating from the angle of the eyelids, these folds become permanent in senescence. This part comprises two pieces, Horners muscle and the muscle of Riolan, the latter helps hold the eyelids together to keep the lacrimal passage waterproof. Associated pathology, such as a lesion of the facial nerve seen in Bells palsy results in the inability to blink or close the ipsilateral eyelid, subsequent lack of irrigation increases the risk of corneal inflammation and ulcers. As well as inactive control from the orbicularis oculi, the levator superior aponeurosis actively contributes to size of aperture and it starts at the apex of the orbit as a thin tendon, and broadens until it reaches the eyelids, between the tarsal plate and the skin. Since it is connected with other muscles that move the eye proper the eye tends to move up with the upper eyelid, both the levator and the orbicularis are striated and voluntary. It is involved in the cornea reflex and this can be used to examine the facial nerve even in unconscious patients. A number of muscles assist in cooperating with the eyelid muscles. The procerus muscles, in the bridge of the nose, arise from the nasal bone to the lower forehead. The procerus muscles pull the skin into horizontal wrinkles, the frontalis muscle, which runs from the upper forehead, halfway between the coronal suture and the top edge of the orbit, attaches to the eyebrow skin. Since it pulls the eyebrows upward, it is the antagonist of the orbicularis oculi and it is used in looking up, and increasing vision if there is insufficient light or when objects are far away. This article incorporates text in the domain from the 20th edition of Grays Anatomy PTCentral

18.
Botox
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Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, infection with the bacterium causes the disease botulism. The toxin is used commercially in medicine, cosmetics. Botulinum is the most acutely lethal toxin known, with an estimated median lethal dose of 1. 3–2.1 ng/kg intravenously or intramuscularly. The U. S. Food and Drug Administration requires a warning stating that when locally administered the toxin may spread from the injection site to other areas of the body. The warning was the result of associated with its uses. There are seven types of toxin, named type A–G. Type A and B are capable of causing disease in humans, types C–G are less common, types E and F can cause disease in humans, while the other types cause disease in other animals. Botulinum toxin types A and B are used in medicine to treat muscle spasms. The commercial form is marketed under the brand name Botox, among others, botulinum toxin is used to treat a number of problems. Similarly, botulinum toxin is used to relax clenching of muscles, including those of the oesophagus, jaw, lower urinary tract and bladder and it may also be used for improper eye alignment. In cosmetic applications, botulinum toxin is considered safe and effective for reduction of facial wrinkles, injection of botulinum toxin into the muscles under facial wrinkles causes relaxation of those muscles, resulting in the smoothing of the overlying skin. Smoothing of wrinkles is usually three days after treatment and is maximally visible two weeks following injection. The treated muscles gradually regain function, and generally return to their former appearance three to four months after treatment, muscles can be treated repeatedly to maintain the smoothed appearance. Botulinum toxin is used to treat disorders of hyperactive nerves including excessive sweating, neuropathic pain. In addition to uses, botulinum toxin is being evaluated for use in treating chronic pain. While botulinum toxin is considered safe in a clinical setting. Most commonly, botulinum toxin can be injected into the muscle group or spread from the injection site

19.
Artery
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Arteries are blood vessels that carry blood away from the heart. While most arteries carry oxygenated blood, there are two exceptions to this, the pulmonary and the umbilical arteries, the effective arterial blood volume is that extracellular fluid which fills the arterial system. The anatomy of arteries can be separated into gross anatomy, at the level, and microscopic anatomy. The outermost layer is known as the tunica externa, also known as tunica adventitia, inside this layer is the tunica media, or media, which is made up of smooth muscle cells and elastic tissue. The innermost layer, which is in contact with the flow of blood, is the tunica intima. This layer is made up of endothelial cells. The hollow internal cavity in which the flows is called the lumen. Arterial formation begins when endothelial cells begin to express specific genes. Arteries form part of the circulatory system and they carry blood that is oxygenated after it has been pumped from the heart. Arteries also aid the heart in pumping blood, arteries carry oxygenated blood away from the heart to the tissues, except for pulmonary arteries, which carry blood to the lungs for oxygenation. Veins and pulmonary veins carry deoxygenated blood. )The pulmonary artery carries blood from the heart to the lungs and it is unique because the blood in it is not oxygenated, as it has not yet passed through the lungs. The other unique artery is the artery, which carries deoxygenated blood from a fetus to its mother. Arteries have a blood pressure than other parts of the circulatory system. The pressure in arteries varies during the cardiac cycle and it is highest when the heart contracts and lowest when heart relaxes. The variation in pressure produces a pulse, which can be felt in different areas of the body, arterioles have the greatest collective influence on both local blood flow and on overall blood pressure. They are the primary adjustable nozzles in the system, across which the greatest pressure drop occurs. The larger arteries are generally elastic and the smaller ones tend to be muscular, systemic arteries deliver blood to the arterioles, and then to the capillaries, where nutrients and gases are exchanged. After travelling from the aorta, blood travels through peripheral arteries into smaller arteries called arterioles, arterioles help in regulating blood pressure by the variable contraction of the smooth muscle of their walls, and deliver blood to the capillaries

20.
Facial artery
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The facial artery is a branch of the external carotid artery that supplies structures of the superficial face. The facial artery is remarkably tortuous and this is to accommodate itself to neck movements such as those of the pharynx in deglutition, and facial movements such as those of the mandible, lips, and cheeks. It lies upon the middle pharyngeal constrictor and the superior pharyngeal constrictor, on the face, where it passes over the body of the mandible, it is comparatively superficial, lying immediately beneath the dilators of the mouth. In its course over the face, it is covered by the integument, the fat of the cheek, and, near the angle of the mouth, by the platysma, risorius, and zygomaticus major. It rests on the buccinator and levator anguli oris, and passes either over or under the head of the levator labii superioris. The anterior facial vein lies lateral/posterior to the artery, and takes a direct course across the face. In the neck it lies superficial to the artery, the branches of the facial nerve cross the artery from behind forward. The facial artery anastomoses with the dorsal artery of the internal carotid artery. Anatomy photo,31, 09-0106 at the SUNY Downstate Medical Center - Common Carotid Artery and Branches of the External Carotid Artery

21.
Superficial temporal artery
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In human anatomy, the superficial temporal artery is a major artery of the head. It arises from the carotid artery when it bifurcates into the superficial temporal artery and maxillary artery. Its pulse is palpable superior to the arch, anterior and superior to the tragus. The superficial temporal artery is the smaller of two branches that bifurcate superiorly from the external carotid. Based on its direction, the temporal artery appears to be a continuation of the external carotid. The superficial temporal artery anastomoses with the artery of the internal carotid artery. The superficial temporal artery is often affected in giant-cell arteritis and biopsied if the diagnosis is suspected, migraine attacks can occur when the temporal artery enlarges. edu http, //www. dartmouth. edu/~humananatomy/figures/chapter_47/47-2. HTM

22.
Vein
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Veins are blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the back to the heart, exceptions are the pulmonary and umbilical veins. In contrast to veins, arteries carry blood away from the heart, veins are less muscular than arteries and are often closer to the skin. There are valves in most veins to prevent backflow, veins are present throughout the body as tubes that carry blood back to the heart. Veins are classified in a number of ways, including superficial vs. deep, pulmonary vs. systemic, superficial veins are those closer to the surface of the body, and have no corresponding arteries. Deep veins are deeper in the body and have corresponding arteries, perforator veins drain from the superficial to the deep veins. These are usually referred to in the limbs and feet. Communicating veins are veins that directly connect superficial veins to deep veins, pulmonary veins are a set of veins that deliver oxygenated blood from the lungs to the heart. Systemic veins drain the tissues of the body and deliver deoxygenated blood to the heart, most veins are equipped with valves to prevent blood flowing in the reverse direction. Veins appear blue because the subcutaneous fat absorbs low-frequency light, permitting only the highly energetic blue wavelengths to penetrate through to the dark vein and reflect back to the viewer. The colour of a vein can be affected by the characteristics of a skin, how much oxygen is being carried in the blood. When a vein is drained of blood and removed from an organism, the largest veins in the human body are the venae cavae. These are two large veins which enter the right atrium of the heart from above and below. The superior vena cava carries blood from the arms and head to the atrium of the heart, while the inferior vena cava carries blood from the legs. The inferior vena cava is retroperitoneal and runs to the right, large veins feed into these two veins, and smaller veins into these. Together this forms the venous system, whilst the main veins hold a relatively constant position, the position of veins person to person can display quite a lot of variation. The pulmonary veins carry relatively oxygenated blood from the lungs to the heart, the superior and inferior venae cavae carry relatively deoxygenated blood from the upper and lower systemic circulations, respectively. The portal venous system is a series of veins or venules that directly connect two capillary beds, examples of such systems include the hepatic portal vein and hypophyseal portal system

23.
Nerve
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A nerve is an enclosed, cable-like bundle of axons in the peripheral nervous system. A nerve provides a pathway for the electrochemical nerve impulses that are transmitted along each of the axons to peripheral organs. In the central system, the analogous structures are known as tracts. Each nerve is a structure containing bundles of axons. Within a nerve, each axon is surrounded by a layer of tissue called the endoneurium. The axons are bundled together into groups called fascicles, and each fascicle is wrapped in a layer of tissue called the perineurium. Finally, the nerve is wrapped in a layer of connective tissue called the epineurium. Efferent nerves conduct signals from the nervous system along motor neurons to their target muscles. Mixed nerves contain both afferent and efferent axons, and thus conduct both incoming sensory information and outgoing muscle commands in the same bundle and they are given letter-number designations according to the vertebra through which they connect to the spinal column. Cranial nerves innervate parts of the head, and connect directly to the brain and they are typically assigned Roman numerals from 1 to 12, although cranial nerve zero is sometimes included. In addition, cranial nerves have descriptive names, each nerve is covered externally by a dense sheath of connective tissue, the epineurium. Underlying this is a layer of cells, the perineurium. Perineurial septae extend into the nerve and subdivide it into several bundles of fibres, surrounding each such fibre is the endoneurium. This forms a tube from the surface of the spinal cord to the level where the axon synapses with its muscle fibres. The endoneurium consists of a sleeve of material called the glycocalyx. Nerves are bundled along with vessels, since the neurons of a nerve have fairly high energy requirements. Within the endoneurium, the nerve fibres are surrounded by a low protein liquid called endoneurial fluid. This acts in a way to the cerebrospinal fluid in the central nervous system

24.
Medical Subject Headings
–
Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences, it serves as a thesaurus that facilitates searching. Created and updated by the United States National Library of Medicine, it is used by the MEDLINE/PubMed article database, MeSH is also used by ClinicalTrials. gov registry to classify which diseases are studied by trials registered in ClinicalTrials. gov. MeSH was introduced in 1960, with the NLMs own index catalogue, the yearly printed version of MeSH was discontinued in 2007 and MeSH is now available online only. It can be browsed and downloaded free of charge through PubMed, originally in English, MeSH has been translated into numerous other languages and allows retrieval of documents from different languages. The 2009 version of MeSH contains a total of 25,186 subject headings, most of these are accompanied by a short description or definition, links to related descriptors, and a list of synonyms or very similar terms. This additional information and the structure make the MeSH essentially a thesaurus. The descriptors or subject headings are arranged in a hierarchy, a given descriptor may appear at several locations in the hierarchical tree. The tree locations carry systematic labels known as numbers. The tree numbers of a given descriptor are subject to change as MeSH is updated, every descriptor also carries a unique alphanumerical ID that will not change. Most subject headings come with a description or definition. See the MeSH description for diabetes type 2 as an example, the explanatory text is written by the MeSH team based on their standard sources if not otherwise stated. References are mostly encyclopaedias and standard textbooks of the subject areas, references for specific statements in the descriptions are not given, instead readers are referred to the bibliography. In addition to the hierarchy, MeSH contains a small number of standard qualifiers. For example, Measles is a descriptor and epidemiology is a qualifier, the epidemiology qualifier can be added to all other disease descriptors. Not all descriptor/qualifier combinations are allowed some of them may be meaningless. In all there are 83 different qualifiers, in addition to the descriptors, MeSH also contains some 139,000 supplementary concept records. These do not belong to the vocabulary as such, instead they enlarge the thesaurus. Many of these records describe chemical substances, by default, a search for a descriptor will include all the descriptors in the hierarchy below the given one

Temporal fascia
–
The temporal fascia covers the Temporalis muscle. It is a strong, fibrous investment, covered, laterally, by the Auricularis anterior and superior, by the galea aponeurotica, the superficial temporal vessels and the auriculotemporal nerve cross it from below upward. A small quantity of fat, the branch of the superficial temporal artery. It affords

1.
The Temporalis; the zygomatic arch and Masseter have been removed.

Skin
–
Skin is the soft outer tissue covering vertebrates. Other animal coverings, such as the arthropod exoskeleton have different developmental origin, structure, the adjective cutaneous means of the skin. In mammals, the skin is an organ of the system made up of multiple layers of ectodermal tissue. Skin of a different nature exists in amphibians, rept

1.
Skin of an elephant

2.
A close up picture of a rhinoceros skin.

Neck
–
The neck is the part of the body, on many vertebrates, that separates the head from the torso or trunk. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the arteries and jugular veins. In anatomy,

1.
Human neck

2.
Neck of a goose

3.
Giraffes are well known for having a long neck

Twilight anesthesia
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Twilight anesthesia is an anesthetic technique where a mild dose of general anesthesia is applied to induce anxiolysis, hypnosis, and anterograde amnesia. The patient is not unconscious, but sedated, generally, twilight anesthesia causes the patient to forget the surgery and the time right after. It is used for a variety of procedures and for vario

Breast augmentation
–
A breast implant is a prosthesis used to change the size, shape, and contour of a woman’s breast. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery, there are three general types of breast implant devices, defined by their filler material, saline solution, silicone gel, and compos

Abdominoplasty
–
Abdominoplasty or tummy tuck is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of skin and fat from the middle and lower abdomen in order to tighten the muscle. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss, abdomin

1.
Abdominoplasty before & after.

2.
Reconstruction of the umbilicus (belly button) following an abdominoplasty surgery. The original umbilicus is sutured into a new hole created by the surgeon.

3.
The completely sutured area where nearly 100 square centimeters of skin was removed during a combination abdominoplasty and liposuction procedure (also known as a "lipo-tuck"). Note the "neo"-umbilicus (belly button) that was reattached to a newly created hole.

4.
Abdominoplasty surgery is a cosmetic operation that is performed by a plastic surgeon to thin the abdominal region.

Periosteum
–
The periosteum is a membrane that covers the outer surface of all bones, except at the joints of long bones. Endosteum lines the surface of all bones. The periosteum consists of irregular connective tissue. It is divided into a fibrous layer and inner cambium layer. The fibrous layer contains fibroblasts, while the layer contains progenitor cells t

1.
The periosteum covers the outside of bones.

2.
The periosteum consists of an inner osteogenic layer and an outer fibrous layer

Berlin, Germany
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Berlin is the capital and the largest city of Germany as well as one of its constituent 16 states. With a population of approximately 3.5 million, Berlin is the second most populous city proper, due to its location in the European Plain, Berlin is influenced by a temperate seasonal climate. Around one-third of the area is composed of forests, parks

Harold Gillies
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Sir Harold Delf Gillies was a New Zealand-born, and later London-based, otolaryngologist who is widely considered the father of plastic surgery. Gillies was born in Dunedin, New Zealand, following the outbreak of World War I he joined the Royal Army Medical Corps. Gillies, eager after seeing Valadier experimenting with nascent skin graft techniques

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Walter Yeo, a sailor injured at the Battle of Jutland, is assumed to be the first person to receive plastic surgery in 1917. The photograph shows him before (left) and after (right) receiving a flap surgery performed by Gillies.

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Frognal House, formerly Queen Mary's Hospital, in 2002

Platysma
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The platysma is a superficial muscle that overlaps the sternocleidomastoid. It is not a true symphysis as there is no cartilage between the two sides of the mandible. Fibres at the back of the cross the mandible, some being inserted into the bone below the oblique line, others into the skin. Many of these fibers blend with the muscles about the ang

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The platysma is visible, with skin removed.

Craniofacial surgery
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Although craniofacial treatment often involves manipulation of bone, craniofacial surgery is not tissue-specific, i. e. craniofacial surgeons deal with bone, skin, nerve, muscle, teeth, etc. Training in craniofacial surgery requires completion of a Craniofacial surgery fellowship, such fellowships are available to individuals who have completed res

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Fig. 3 Locations of the incisions used in fronto-supraorbital advancement.

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Fig. 1 Cranial sutures viewed from top of head

Subperiosteal
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The periosteum is a membrane that covers the outer surface of all bones, except at the joints of long bones. Endosteum lines the surface of all bones. The periosteum consists of irregular connective tissue. It is divided into a fibrous layer and inner cambium layer. The fibrous layer contains fibroblasts, while the layer contains progenitor cells t

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The periosteum covers the outside of bones.

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The periosteum consists of an inner osteogenic layer and an outer fibrous layer

Dissection
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Dissection, is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause of death in humans and it is carried out by or demonstrated to biology and anatomy students in high school and medical school. Less advanced courses typically focus on

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Dissection of a pregnant rat, done in a biology class

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Ginko seed in dissection, showing embryo and gametophyte.

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Illustration of a dissection (De Re Anatomica, 1559).

Anatomical terms of location
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Standard anatomical terms of location deal unambiguously with the anatomy of animals, including humans. All vertebrates have the basic body plan – they are strictly bilaterally symmetrical in early embryonic stages. That is, they have left and right halves if divided down the centre. For these reasons, the directional terms can be considered to be

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Unique anatomical terminology is used to describe humans and other animals. Because of differences in the way humans and other animals are structured, different terms are used depending on the neuraxis and whether an animal is a vertebrate and invertebrate.

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A jellyfish of the Chrysaora species. Like other animals, its appendages move, and in this image are not in a standard anatomical position. In anatomical position, the proximodistal axis (labelled) is straight, and the point labelled "distal end" neither to the left or the right of the jellyfishes' main axis.

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Anatomical planes in a human

Rejuvenation (aging)
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Rejuvenation is a medical discipline focused on the practical reversal of the aging process. Rejuvenation is distinct from life extension, life extension strategies often study the causes of aging and try to oppose those causes in order to slow aging. Rejuvenation is the reversal of aging and thus requires a different strategy, rejuvenation can be

Nasolabial fold
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The nasolabial folds, commonly known as smile lines or laugh lines, are facial features. They are the two skin folds that run from side of the nose to the corners of the mouth. They are defined by facial structures that support the fat pad. They separate the cheeks from the upper lip, the term derives from Latin nasus for nose and labium for lip. W

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Human face, with left nasolabial fold marked in black ellipse

Orbicularis oculi muscle
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The orbicularis oculi is a muscle in the face that closes the eyelids. There are at least 3 clearly defined sections of the orbicularis muscle, however, it is not clear whether the lacrimal section is a separate section, or whether it is just an extension of the Preseptal orbicularis and the Pretarsal orbicularis sections. The palpebral portion con

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Muscles of head and neck

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Orbicularis oculi muscle

Botox
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Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, infection with the bacterium causes the disease botulism. The toxin is used commercially in medicine, cosmetics. Botulinum is the

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Botulinum toxin A

Artery
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Arteries are blood vessels that carry blood away from the heart. While most arteries carry oxygenated blood, there are two exceptions to this, the pulmonary and the umbilical arteries, the effective arterial blood volume is that extracellular fluid which fills the arterial system. The anatomy of arteries can be separated into gross anatomy, at the

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Microscopic anatomy of the artery.

Facial artery
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The facial artery is a branch of the external carotid artery that supplies structures of the superficial face. The facial artery is remarkably tortuous and this is to accommodate itself to neck movements such as those of the pharynx in deglutition, and facial movements such as those of the mandible, lips, and cheeks. It lies upon the middle pharyng

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Facial atrery

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The arteries of the face and scalp. (External maxillary visible at bottom center.)

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Facial artery

Superficial temporal artery
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In human anatomy, the superficial temporal artery is a major artery of the head. It arises from the carotid artery when it bifurcates into the superficial temporal artery and maxillary artery. Its pulse is palpable superior to the arch, anterior and superior to the tragus. The superficial temporal artery is the smaller of two branches that bifurcat

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Lateral head anatomy detail

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Outline of side of face, showing chief surface markings. (Superficial temporal a. visible at center, to left of ear.)

Vein
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Veins are blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the back to the heart, exceptions are the pulmonary and umbilical veins. In contrast to veins, arteries carry blood away from the heart, veins are less muscular than arteries and are often closer to the skin. There are valves in most veins to prevent

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Veins of the head and neck. ("Sup. Temp." labeled at center, anterior to the ear.)

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Head anatomy anterior view

Nerve
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A nerve is an enclosed, cable-like bundle of axons in the peripheral nervous system. A nerve provides a pathway for the electrochemical nerve impulses that are transmitted along each of the axons to peripheral organs. In the central system, the analogous structures are known as tracts. Each nerve is a structure containing bundles of axons. Within a

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Distribution of the maxillary and mandibular nerves, and the submaxillary ganglion. (Mental nerve visible at bottom right, at chin.)

Medical Subject Headings
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Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences, it serves as a thesaurus that facilitates searching. Created and updated by the United States National Library of Medicine, it is used by the MEDLINE/PubMed article database, MeSH is also used by ClinicalTri